New Client Enquiry Form

Thank you for interest in booking with Mullumbimby Psychology. 

This is our new client enquiry form. Upon completion, you will be added to our waitlist or contacted if an appointment is available. 

This form takes approximately 10 minutes to complete.

Click the next button to get started...


Enquirer Details

These are the details of person completing this form.


Please provide at least one phone number:


If you are seeking more than one service - please complete a separate enquiry form for each service

This information is used to determine conflicts of interest, if applicable.

(e.g. court order details)

Separated Parents: 

Please carefully read the critical information summary at the following link: https://mullumbimbypsychology.com.au/separated-parents/


Referral Details

Please see your GP for a long appointment (usually 20 minutes) to request a Mental Health Care Plan. Medicare rebates are only available for eligible GP referrals (e.g. Mental Health Care Plan, Enhanced Primary Care plan, Eating Disorder Plan). 

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(if available)

Payment Information

Our practice requires a deposit of 50% of the consult fee to be paid in order to secure your first appointment. If the intial booking is made over the phone, we will request card details to charge this deposit.

With your permission, your card details are stored in a secure, encrypted system. These card details are maintained on file for future use in the event that you incur cancellation fees or have Telehealth sessions (video/phone). 

This deposit is then credited towards your first consult unless you do not attend or cancel within 48 hours' (2 business days) and we are unable to fill the appointment for the clinician.

 Please find our cancellation policy as well as details of our fees at the following link: https://mullumbimbypsychology.com.au/fees/.



Needs and Preferences


Reports, Letters, and Assessments

Please note that we are unable to provide some types of reports, letters, and assessments. If we are unable to provide a requested report, letter, or assessment, we will contact you to confirm if you’d like to still attend for treatment and to suggest alternative providers where possible. 

Please note that production of reports, letters, or assessments which we are able to produce are not guaranteed and will be approved at discretion of the treating psychologist according to their clinical judgement and within the course of treatment, as per the Australian Psychological Society Code of Ethics.

These items often incur costs in addition to standard treatment charges, as they require additional hours of work outside of sessions. We will quote you for any reports, letters, or assessments in advance so you can decide if you wish to proceed. 


Availability and Psychologist Preferences

Please note have limited availability for psychologists on Saturdays
Mullumbimby Psychology operates within the hours of 9am-5pm on weekdays. Please note limited appointments are available out-of-hours and on weekends.

For information about our psychologists, such as experience, working days, and psychologist status (i.e. Clinical, Registered, Provisional), please see the following link: https://mullumbimbypsychology.com.au/meet-the-team/

Psychologists who are not listed above have closed their waitlist due to long wait times.

If you wish to see a specific psychologist, there is likely to be a longer wait.